I Love Calling Patients – And I Don’t

That is, I don’t do it very much and I don’t love it with all my heart.

Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark yellow. So, while still on the phone, I e-prescribed a different antibiotic, after going over her long list of allergies with her.

But as a primary care doctor with a productivity target of 24 patients per day, and absolutely no credit for phone calls, this is not something I am incentivized to do.

So instead, I am tempted to resort to the internal EMR messages:

“Mrs. Jones is looking for her CT results, please advise.”

I could have typed in what to tell he patient, but then when the medical assistant had her on the phone, she probably (hopefully) would have mentioned that she was still raising dark yellow sputum. The medical assistant would then tell her she’d check with me and get back to her.

Would I have remembered that the levofloxacin the ER gave her caused horrific nightmares if I hadn’t been engaged in conversation with her? Maybe I would have just tried to refill that?

How many back and forth messages would it take to handle something as simple as this, and how many times would the medical assistant need to call the patient back to get all the necessary information?

If all work we do was recognized as work, if Medicare and Medicaid paid our clinics for phone calls, doctors would have time in their schedules to personally return patient calls. (Medicare does, but so far only for people we sign up for chronic care management where they will incur monthly copays for this “added service”, mostly designed for nurse calls).

Some commercial insurers now do pay for phone calls, but in Federally Qualified Health Centers, where I work, private insurance is such a minor portion of our payer mix that their reimbursement policies are close to irrelevant for our bottom line.

The struggle in primary care is that right now, we get paid “per visit” with very little regard to “outcomes”, but very soon, our clinics will prosper or perish depending on how well our patients do and how much they cost “the system”. I talk with my bosses every week about how we can make this transition without losing our shirts.

Mrs. Jones, if I hadn’t called her myself, might have gone back to the emergency room several days later, in terrible shape, required admission to the hospital and incurred thousands of dollars of cost. My doxycycline prescription may have avoided that.

And, being able to personally get back to patients fosters loyalty and provides levels of reassurance that only come with the role of the physician.

Darn it, that’s what I am, and that is what I need to provide as much as I can of.

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2 Responses to “I Love Calling Patients – And I Don’t”

The telephone has been the bane of the Doctor’s Office forever, with the newer intrusion of the Patient Portal and email. Endocrinology depends on the lab, so people come with branch points which gets them sent back for diagnostics or a decision on treatment is made for which they are told to call their glucoses in 10 days. A lot of them do. None of the lab reporting or tweaking of insulin dosing requires face to face contact but the volume of this task can be daunting. My network gives me a half day a week outpatient free which is largely absorbed reviewing lab results with a not to the front desk to report things that need no decision and those that do, I have to chase down. They are not always home when I call. The fax is a variant of phone, so pharmacies send notes on renewals and patients call. Of course there are the misadventures of hypoglycemia and statin myalgia that need attention. And those are my phone calls. The front desk has to deal with appointments, messages from the answering service, calls to forward to me or the two other docs in the suite, and complaints about their bill, which is usually handled by somebody else in the network but they get the calls.

A while back, the LBJ tapes were made public and much of them were televised. Amid the soundtrack they mostly had selected still pictures of a smiling President appearing energized as he talked to various people on the phone, some key advisors, the previous President’s widow, some world leaders, and people with whom he just wanted to chat. The telephone was his friend, partly enabling his agenda, partly to keep this man who really liked being among people from being isolated by the burdens of the Oval Office. For me, the telephone was never my friend, always an intrusion in some form, a thankless unpaid one.